HEPATITIS-ASSOCIATED APLASTIC-ANEMIA

Background Hepatitis-associated aplastic anemia is a variant of aplast ic anemia in which aplastic anemia follows an acute attack of hepatiti s. The aplastic anemia, however, is often fatal if untreated. To chara cterize the illness, investigate the role of hepatitis viruses, and as sess the response to immunosuppressive treatment, we studied patients with the syndrome who were referred to the National Institutes of Heal th (NIH). Methods Standard hematologic and biochemical tests and measu rements of bone marrow cellularity were used to monitor the patients' response to treatment. Serum was assayed for antibodies and antigens r elated to hepatitis A, B, and C viruses and for the RNA of hepatitis C and GB virus C by the polymerase chain reaction. All patients were tr eated with antithymocyte globulin and cyclosporine. Results Ten patien ts with hepatitis-associated aplastic anemia were referred to the NIH between 1990 and 1996; all had the typical features of this syndrome. There was evidence of activated CD8 T lymphocytes in the blood. Serolo gic tests for hepatitis A, B, and C viruses were negative; RNA of hepa titis C virus was undetectable in all patients, but RNA of GB virus C was detected in three patients. Seven of the patients responded to int ensive immunosuppressive treatment; the three who did not respond all died within one year of treatment, two from complications of stem-cell or marrow transplantation. Conclusions The hepatitis of the hepatitis -associated aplastic anemia does not appear to be caused by any of the known hepatitis viruses. We recommend immunosuppressive treatment for patients who do not have an HLA-matched related donor available for b one marrow transplantation. Several features of the syndrome suggest t hat it is mediated by immunopathologic mechanisms. (C) 1997, Massachus etts Medical Society.